The
Mississippi Department of Health recommends best practices for overcoming the
most common barriers to addressing social determinants of health inequities in
rural areas.
November 14, 2019
- In rural Mississippi, geographic barriers and social determinants of
health can get in the way of residents leading healthy lives. But connections
with key community partners and a strong
infrastructure for addressing social risk factors have helped the state
close some of those gaps.
Rural areas of the country carry a higher
burden of disease than their urban counterparts, but the residents of these
remote areas often have to travel farther distances to receive high-quality
care.
Over half of the
population of Mississippi lives in a rural area, according to data from the United States Department of
Agriculture. As a result, the state’s health department places a particular
emphasis on their rural and minority populations when implementing
evidence-based practices.
“The focus of our
office is around prevention and working upstream, trying to get to the root
causes and address those issues so we won’t have to deal with things on the
backend when it can become a bit more challenging,” Director of the Office of
Preventive Health and Health Equity Victor Sutton, PhD, MPPA, told PatientEngagementHIT.com.
According to the American Community
Survey, the poverty rate in Mississippi’s rural areas is 23.1 percent compared
to 15.9 percent in urban areas. Nearly 20 percent of rural populations in the
state do not have a high school degree compared to 13.2 percent of urban
populations. These disparities are why Sutton said his department focus on
upstream factors of health.
“We work with mayors, superintendents,
principals, the health community, service providers, private doctors, community
health centers, faith-based organizations, barbers, and those kinds of things,”
he said. “It’s a policy systems approach working with evidence-based activities
to create an environment that allows for optimal health.”
Sutton’s office uses
a Policy, Systems, and Environmental Change (PSE) framework when thinking about improving
health outcomes. This method promotes leveraging policy and systems-level
thinking to change the environment to promote healthy habits and accessibility.
The policy component of this framework can look at state-level policy,
advocating to legislators and congressmen, or local policies such as smoke-free
parks.
Regardless of the
policy area of focus, the emphasis is placed on the root cause of these
disparities.
“You have to work
upstream. If you don’t, you’re going to deal with a lot more costs on the
backend”, Sutton stressed. “Insurance providers understand that, so they need
to spend more investment on the front end to keep folks healthy.”
Currently, Sutton and
his team offer programs to combat a multitude of risk factors and diseases
including diabetes, cancer prevention, obesity, injury prevention, school
health programs, and community engagement.
“We didn’t get here overnight,” he furthered.
“We understand health is tied to education, employment, housing, and
transportation. All this stuff can create an environment for healthier
outcomes.”
In order to gain
momentum for their programs, Sutton and his team began by building evidence
that their programs and strategies were effective.
“We want to do what
we know works or what has shown some evidence of working in other places. We
take those programs and implement them in our communities and try to hold the
fidelity of the program to be consistent,” he noted.
And to demonstrate
that success, the team focused on measurement. These measurements included
process measures to evaluate the reach of their programs and outcome measures
to evaluate their effectiveness in changing health outcomes.
“Everything that we
do, we try to evaluate. There’s really good information you can get around
understanding the process and how we do things,” Sutton explained. “There’s a
story to be told in that. We go as far sometimes just to see how many people we
are actually reaching.”
At the other end of
the spectrum, Sutton said it is important to look at outcome measures despite
these being difficult to capture.
“Some of the best
measures are that something did not happen,” Sutton stressed. “A lot of the
work we do focuses on prevention. If we do our work right, then we find folks
not in and out of the hospital.”
It is also
challenging to understand if the impact on outcomes is the direct result of the
work by Sutton and his team.
“We’re one cog
working with our partners to improve outcomes and improve the environment so
that we can make the healthy choice the optimal, easy, and affordable choice,”
he observed.
Leveraging
partnerships with a variety of organizations has helped Sutton succeed in his
mission. These partnerships can be community-based organizations, fellow
government organizations, or faith-based organizations.
Partnerships with
local schools have been particularly powerful, Sutton highlighted.
“We understand that
kids spend a fair amount of time in schools. Making those environments healthy
and promoting healthy policies are very important,” he noted.
He explained that
schools have facilities that could be leveraged for the entire community, not
just the students attending them.
“Those schools
typically have gyms and tracks. Those things should be opened up to communities
in the form of a shared-use agreement to provide access to folks in that
particular community to promote physical activity,” Sutton continued.
Exploring these
unique partnerships is one of the ways Sutton and his department have overcome
two of the largest barriers to tackling health disparities in rural areas:
inaccessibility of services and limited transportation.
“Access issues are
real,” Sutton said. “It’s not foreign for someone to say, ‘I can’t come because
I don’t have a ride.’ We have challenges around transportation.”
“There are social
determinants that come into play,” Sutton furthered. “We’re trying to put these
everyday evidence-based programs in place, understanding that sometimes things
are not as equitable.”
Sutton is not
deterred, though.
“We know there are challenges,” Sutton concluded. “What may work in
Jackson may not work in Delta, let alone in another state. We understand there
are differences to cultures, but we’re really excited about trying to help
build the evidence.”
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